Charles L. Crocker, DDS
Individual provider Active NPI General Practice Dentistry · Monticello, FL
NPI 1487661963 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1487661963
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DN 7229 (FL)
- Practice address
- 952 Mahan Dr
Monticello, FL 32344-1136 - Phone
- (850) 997-3984
- NPI assigned
- Aug 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN 7229 | FL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN 7229 | FL | Yes |
Addresses
Primary practice location
952 Mahan Dr
Monticello, FL 32344-1136
Mailing address
952 W Mahan Dr
Monticello, FL 32344
Phone (850) 997-3984
Other providers in Monticello, FL
- Kortney Clinton
- Complete Medical LLC
- Judith Crocker Corbin
- County of Jefferson Office of Clerk Circuit Court
- Covington Legacy Incorporated
- Cross Landings
- Robert B Deem
- Delta Health Group Inc
- Cashanda Dennis
- Doh
All providers in Monticello, FL · General Practice Dentistry in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.